急性有機(jī)磷農(nóng)藥中毒的護(hù)理查房課件

急性有機(jī)磷農(nóng)藥中毒的護(hù)理查房

Acuteorganophosphatepesticidepoisoning（AOPP）carerounds2011/8/18.急性有機(jī)磷農(nóng)藥中毒的護(hù)理查房Acuteorganopho1病例介紹伍南臻患者，周桂云，女性，46歲入院時(shí)間：2011-08-07主訴：嘔吐、口吐白沫、神志不清、大小便失禁4小時(shí)

Patients,guiyunZhou,female,46yearsoldAdmissiontime：2011-08-07ChiefComplaint:vomiting,foamingatthemouth,confusion,incontinence4hours基本資料1.病例介紹2病例介紹現(xiàn)病史：患者于4小時(shí)前因爭吵后自服農(nóng)藥（半硫磷）約100ML，服用后出現(xiàn)神志改變。Historyofpresentillness,Forfourhoursafteranargumentwithhisfamilybefore,Shetakethepesticideabout100Milliliters,Pesticidesconsideredforthehalfsulphurphosphoric.Aftertakeappearmindchange.

.病例介紹現(xiàn)病史：患者于4小時(shí)前因爭吵后自服農(nóng)藥（半硫磷）約13病例介紹家人行緊急救治后送入當(dāng)?shù)蒯t(yī)院行洗胃治療，于2011-08-0712:20急診平車轉(zhuǎn)入我院腎病內(nèi)科Patientsaftermedicationwithvomiting,aftertheemergencysalvage,shewassendtothelocalhospitalforgastriclavageforherfamliy.Inaugust7,201112:20,Shewastransferredtoourhospitalnephropathyinternalmedicinewithemergencyflatcar..病例介紹家人行緊急救治后送入當(dāng)?shù)蒯t(yī)院行洗胃治療，于2011-4病例介紹轉(zhuǎn)運(yùn)途中出現(xiàn)嘔吐，大小便失禁癥狀。門診以“急性有機(jī)磷農(nóng)藥中毒”收治。起病以來，精神差，體重?zé)o明顯變化。Intransit,PatientshadrepeatedvomitingandEliminationofurineandfecesarenotcontrolledbyherself,ClinicdiagnosisisAOPP,Afterthepatientisadmittedtohospital,herSpiritwassobadandweightdidnothavesignificantlychange..病例介紹轉(zhuǎn)運(yùn)途中出現(xiàn)嘔吐，大小便失禁癥狀。門診以“急性有機(jī)磷5病例介紹既往有肺膿腫病史，已行部分肺葉切除術(shù)，術(shù)中有輸血，有青霉素過敏史。shehadlungabscessbefore,andwasdoneapartiallobectomy,inthatoperation,Shehadabloodtransfusion.ThemostimportantisshehadthePenicillinallergy..病例介紹既往有肺膿腫病史，已行部分肺葉切除術(shù)，術(shù)中有輸血，有6病例介紹全鳳春體格檢查：T35.8℃P126次/分R20次/分BP109/69mmHgPhysicalexamination:Temperature：35.8℃,Pulse:126BeatPerMinute,respiration:20BeatPerMinute,BloodPress109/69mmHg.病例介紹全鳳7病例介紹神志淺昏迷，雙側(cè)瞳孔等大等圓3mm,對(duì)光反射遲鈍，口唇發(fā)紺，皮膚濕冷，雙肺呼吸音粗，可聞及大量濕性啰音。

Comaconsciousness,Pupilsareequalroundnessandsamesizewith3mm,reactiontolightshowsdelay,whilethelipsiscyanotic,BreathsoundshowsCoarsewhileitCanbeheardandalotofwetrales..病例介紹神志淺昏迷，雙側(cè)瞳孔等大等圓3mm,對(duì)光反射遲鈍，口8病例介紹心率

126次/分，腸鳴音活躍，四肢肌張力稍高，無自主活動(dòng)，病理反射未引出。Heartrateis126BeatPerMinute,borhorygmusshowsincreased,Limbmuscletoneisslightlyhigher,thereisnoindependentactivity,Pathologicalreflexisnotelicited..病例介紹心率126次/分，腸鳴音活躍，四肢肌張力稍高，無自9病例介紹劉偉明入院診斷:1、急性重癥農(nóng)藥中毒（半硫磷）

2、中毒性心肌炎

3、吸入性肺炎Admissiondiagnosis:1、severeacutepesticidepoisoning(halfsulphurphosphorous)2、toxicmyocarditis3、aspirationpneumonia.病例介紹劉偉10主要病情變化馬志群8-801:40T39.1攝氏度，予溫水擦浴

05：20患者開始出現(xiàn)躁動(dòng)，予丙泊酚5毫升IV效果不明顯，予地西泮鎮(zhèn)靜

Onefortyonaugust8th,thepatient’sbodytemperaturerisestothirty-onepointonedegreescelsius,wegivehimawarmwaterbath.Fivetwenty,thepatientbegintoappearrestless,propofulfivemilliliterintravenensinjection,theeffectisnotobvious,tothediazepamsedation..主要病情變化馬志群8-811病例介紹12:30患者躁動(dòng)不安，血氧飽和度波動(dòng)在70%-80%請(qǐng)麻醉科及ICU會(huì)診后考慮氣管插管脫出予重新插管14：50患者轉(zhuǎn)入ICUTwelvethirty,thepatientisrestless,fluctuationsofoxygensatturationinseventypercenttoeightypercent.thenpleaseanesthesiaandintensivecareunitconsulation,consideringtheendotrachealtobeextrusion,toreintubationforhim.Fourteenfifty,thepatientistransforredtotheintensivecareunit.病例介紹12:30患者躁動(dòng)不安，血氧飽和度波動(dòng)在70%-812病例介紹賀舒轉(zhuǎn)入ICU時(shí)情況：體溫37.3℃，脈搏140次/分，呼吸35次/分，血壓116/87mmHg，血氧飽和度95%

WhentransferredtoICUconditions:temperature37.3,pulse140beats/min,breathing35times/min,bloodpressure116/87mmHg,oxygensaturation95%..病例介紹賀13病例介紹神志鎮(zhèn)靜中，躁動(dòng)不安，兩側(cè)瞳孔等大等圓4mm，對(duì)光反射遲鈍，氣管插管，呼吸機(jī)輔助呼吸，氣道內(nèi)少量痰液，皮膚干燥。conscioussedation,irritability,Pupilsareequalroundnessandsamesizewith4mm,reactiontolightshowsdelay,endotrachealintubation,mechanicalventilation,Withinafewairwaysputum,dryskin..病例介紹神志鎮(zhèn)靜中，躁動(dòng)不安，兩側(cè)瞳孔等大等圓4mm，對(duì)光反14病例介紹雙肺可聞及中等量濕性啰音，腹部叩診呈鼓音，診斷為：1.急性有機(jī)磷農(nóng)藥中毒；2.吸入性肺炎、1型呼吸衰竭；3.中毒性心肌炎。double-lungcanbeheardandmoderatemoistrales,Thedrumsoundabdominalsound

Thediagnosisis:1:acuteorganophosphoruspesticidepoisoning;2:aspirationpneumonia,type

1respiratoryfailure;3:toxicmyocarditis..病例介紹雙肺可聞及中等量濕性啰音，腹部叩診呈鼓音，診斷為：115病例介紹予以呼吸機(jī)輔助呼吸，留置胃管，胃腸減壓，留置深靜脈導(dǎo)管，遵醫(yī)囑予抗感染、護(hù)胃、護(hù)心、解毒、導(dǎo)瀉等對(duì)癥支持治療。

Tomechanicalventilation,indwellingstomachtube,decompression,indwellingvenouscatheters,prescribedtofightinfection,protectstomachmucosa,protectionofheartfunction,detoxification,catharsis,symptomaticandsupportivetreatment.

.病例介紹予以呼吸機(jī)輔助呼吸，留置胃管，胃腸減壓，留置深靜脈導(dǎo)16病例介紹蘇敏現(xiàn)患者的情況：神志模糊，躁動(dòng)不安，雙側(cè)瞳孔等大瞪圓3mm,對(duì)光反射遲鈍，皮膚干燥。Thecurrentsituationofpatients:mindfuzzy,restless,Pupilsareequalroundnessandsamesizewith4mm,reactiontolightshowsdelay,theskinisdry..病例介紹17病例介紹有發(fā)熱，最高體溫39℃，予物理降溫。血壓穩(wěn)定，仍給予阿托品間斷靜推。withfever,themaximumtemperatureabout39℃,tothephysicalcooling.Bloodpressurestability,intermittentintravenousinjectionofatropine,.病例介紹有發(fā)熱，最高體溫39℃，予物理降溫。血壓穩(wěn)定，仍給予18病例介紹氣道內(nèi)有少量的黃色痰液，雙肺未聞及濕啰音，四肢有自主活動(dòng)。

therewereafewoftheairwayyellowsputum,doublelungnotsmellandwetgosound,limbshaveindependentactivities..病例介紹氣道內(nèi)有少量的黃色痰液，雙肺未聞及濕啰音，四肢有自主19病例介紹主要的實(shí)驗(yàn)室檢查

8-7WBC27.3*109/L，CHE23KU/L,8-8尿常規(guī)RBC2-4/HP,K+3.38mmol/L,鈣離子1.73mmol/L，CHE10KU/L，心肌酶、肝功能基本正常

ThemainlaboratorytestsOn8-7Thepatient’sWBCis27.3*109/LandCHEis23KU/L.On8-8FormtheRoutineExaminationofUrineonhighpowerlenswecansee2to4redbloodcells,Thepatient’sPotassiumis3.38mmol/L,calciumis1.73mmol/LandCardiacenzymeandliverfunctionarenormal.CHE10.0KU/L.病例介紹主要的實(shí)驗(yàn)室檢查Themainlaborato20病例介紹8-9CHE8.0KU/L,。胸片提示：肺部感染及雙側(cè)胸膜炎。8-12血常規(guī)正常，CHE32KU/L

On8-9,CHE8.0KU/L;ChestXraytip：lunginfectionandbilateralpleurisy.On8-12Bloodroutineisnormal，andCHEis32KU/L.病例介紹8-9CHE8.0KU/L,。胸片提示：肺部感21病因與發(fā)病機(jī)制謝妹娜病因生產(chǎn)及使用過程的不當(dāng)：如生產(chǎn)設(shè)備密封不嚴(yán)導(dǎo)致化學(xué)毒物泄漏；噴灑殺蟲藥過程中經(jīng)皮膚和呼吸道吸收EtiologyImproperproductionanduse:Forexample,productionequipmentsealedpoorlyresultinleakageofchemicaltoxicant;intheprocessofsprayingpesticide,absorbedthroughskinandairway..病因與發(fā)病機(jī)制謝妹娜病因Eti22病因與發(fā)病機(jī)制生活性中毒：主要由于自服、誤服或攝入被污染的水源和實(shí)物水果等。Livingpoisoning:Mainlyduetodrinkingoreatingcontaminatedwaterandfruitvoluntarilyorbymistakeetc..病因與發(fā)病機(jī)制生活性中毒：主要由于自服、誤服或攝入被污染的水23病因與發(fā)病機(jī)制有機(jī)磷農(nóng)藥中毒機(jī)制主要是抑制體內(nèi)膽堿酯酶的活性。正常情況下，膽堿能神經(jīng)興奮所釋放的遞質(zhì)——乙酰膽堿被膽堿酯酶水解為乙酸及膽堿而失去活性。MechanismofpoisoningThePrimarymechanismoforganophosphatepesticidepoisoningisinhibitionoftheactionofcholinesteraseinbody.Ingeneral,excitementofcholinergicnervereleasesneurotransmitter----acetylcholinewhichcanbehydrolyzedtocholineandaceticacidbycholinesteraseandloseitsactivity..病因與發(fā)病機(jī)制有機(jī)磷農(nóng)藥中毒機(jī)制主要是抑制體內(nèi)膽堿酯酶的24病因與發(fā)病機(jī)制有機(jī)磷農(nóng)藥進(jìn)入人體后與體內(nèi)膽堿酯酶迅速結(jié)合形成磷酰化膽堿酯酶，使膽堿酯酶失去水解乙酰膽堿的能力。Onceorganophosphatepesticidesenterintobody,itwillbindrapidlytocholinesteraseandformphosphorylatedcholinesterase,thusmakecholinesteraselosetheabilitytohydrolyzeacetylcholine..病因與發(fā)病機(jī)制有機(jī)磷農(nóng)藥進(jìn)入人體后與體內(nèi)膽堿酯酶迅速結(jié)合形成25病因與發(fā)病機(jī)制導(dǎo)致組織中的乙酰膽堿過量蓄積，產(chǎn)生膽堿能神經(jīng)功能紊亂，先表現(xiàn)為興奮，然后出現(xiàn)抑制。bringoutexcessiveaccumulationofacetycholineintissue,WhichresultindisfunctionofCholinergicNerve.Itmanifestatesexcitementatfirstandtheninhibition..病因與發(fā)病機(jī)制導(dǎo)致組織中的乙酰膽堿過量蓄積，產(chǎn)生膽堿能神經(jīng)功26護(hù)理評(píng)估Nursingassessment袁清紅臨床表現(xiàn)膽堿能危象

急性有機(jī)磷農(nóng)藥中毒的典型表現(xiàn)

ClinicalSituationCholinergic

crisisTypicalperformanceofAOPP

..護(hù)理評(píng)估Nursingassessment27護(hù)理評(píng)估Nursingassessment毒蕈堿樣癥狀主要是副交感神經(jīng)興奮所致,

臨床表現(xiàn)有惡心,嘔吐,腹痛,多汗,流涎,瞳孔

縮小,支氣管痙攣,分泌物增多,心率減慢,氣急,嚴(yán)重者出現(xiàn)肺水腫Muscarinic

symptoms

Mainly

causedby

the

parasympathetic

nervous

excitement,

Clinical

manifestations

have

nausea,vomiting,

abdominal

pain,

sweating,salivation,

miosis,

bronchospasm

and

Increased

secretionsheartratedecreased,dyspnea,theseriouscasesappearpulmonaryedema.

.護(hù)理評(píng)估Nursingassessment毒蕈堿樣癥狀28護(hù)理評(píng)估Nursingassessment

煙堿樣癥狀患者常有肌束顫動(dòng),肌肉強(qiáng)直性痙攣,心率加快,甚至全身抽搐,最后出現(xiàn)肌麻痹,呼吸肌麻痹引起周圍性呼吸衰竭Nicotine-like

symptoms

Patients

often

have

muscle

bundle

oftrembling,

tetanicspasm,heart

rate

increased,Eventhewholebodytwitching,

finally,

myoplegiahappen,breathmyoparalysis

causeperipheral

respiratory

failure

.護(hù)理評(píng)估Nursingassessment煙堿樣癥狀29護(hù)理評(píng)估Nursingassessment

中樞神經(jīng)系統(tǒng)癥狀表現(xiàn)為頭暈,頭痛,疲乏無力,共濟(jì)失調(diào),煩躁不安,意識(shí)模糊,抽搐及昏迷

Central

nervous

system

symptoms

Manifested

as

dizziness,

headache,

fatigue,

ataxia,

irritability,

confusion,

convulsions

and

coma

.護(hù)理評(píng)估Nursingassessment中樞神經(jīng)系30護(hù)理評(píng)估Nursingassessment

莫思慧急性有機(jī)磷中毒分為輕、中、重三級(jí)：輕度中毒：頭暈、頭痛、惡心、嘔吐、多汗、流涎、視力模糊、瞳孔縮小、全血膽堿脂酶活力一般在70％－50％。

AOPPcanbedividedinto3grades:mild,moderate,severeMildpoisoning：dizziness,headache,nausea,vomiting,sweating,salivation,blurredvision,miosis,andthewholebloodcholinesteraseactivitywasinthe50~70%.護(hù)理評(píng)估Nursingassessment莫思31護(hù)理評(píng)估Nursingassessment

中度中毒：除上述癥狀外，還出現(xiàn)肌纖維顫動(dòng)、瞳孔明顯縮小、輕度呼吸困難、大汗、腹痛、腹瀉、意識(shí)清楚或輕度障礙、步態(tài)蹣跚。全血膽堿脂酶活力降至50％－30％。Moderatepoisoning：Inadditiontotheseabove,symptomsalsoincludemuscularfibrillation,milddyspnea,sweat,abdominalpain,diarrhea,clearormilddisordersofconsciousness,andstaggeringgait.Wholebloodcholinesteraseactivitydeclinedto50%-30%.

.護(hù)理評(píng)估Nursingassessment中度中毒：32護(hù)理評(píng)估Nursingassessment

重度中毒：除上述癥狀外，發(fā)生肺水腫、驚厥、昏迷及呼吸麻痹。全血膽堿脂酶活力降至30％以下。

Severepoisoning：Inadditiontotheseabove,symptomsalsoincludepulmonaryedema,convulsions,comaandrespiratoryparalysis.Wholebloodcholinesteraseactivitydeclinedtobelow30%.

.護(hù)理評(píng)估Nursingassessment重度中毒：33護(hù)理評(píng)估Nursingassessment

王麗煒有機(jī)磷農(nóng)藥中毒后，經(jīng)急救臨床癥狀好轉(zhuǎn)，可在數(shù)日到一周內(nèi)突然再次發(fā)生昏迷，甚至發(fā)生肺水腫或突然死亡，此為中毒后反跳現(xiàn)象。

Organophosphoruspesticidepoisoningwerethefirstaidclinicalsymptom,canbeinafewdaystogetbetterwithinaweek,evenhappenagainsuddenlyapulmonaryedemaorsuddendeath,says"bounce"phenomenon..護(hù)理評(píng)估Nursingassessment34護(hù)理評(píng)估Nursingassessment

這與殘留在皮膚、毛發(fā)和胃腸道的有機(jī)磷農(nóng)藥重吸收或解毒藥停用過早或減量過快等原因有關(guān)。Thisandremainintheskin,hairandthegastrointestinaltractisabsorbedbyheavyorantidotetocreditdoseorreasonssuchastooearlyon..護(hù)理評(píng)估Nursingassessment這與殘留在35護(hù)理評(píng)估Nursingassessment

在急性中毒癥狀緩解后遲發(fā)性神經(jīng)病變發(fā)病前，一般在中毒后24~96小時(shí)突然發(fā)生以呼吸肌麻痹為主的癥狀群，稱“中間型綜合征”。

Inpatientswithacutepoisoningsymptomsafterthelate-occurredneuropathy,generallyinthepoisoningbefore24to96hoursafterhappensuddenlybyrespiratorymuscularparalysisprimarilythesymptoms,says"middletypesyndrome".

.護(hù)理評(píng)估Nursingassessment在急性中毒36護(hù)理評(píng)估Nursingassessment

發(fā)病機(jī)制可能與膽堿酯酶長期受到抑制，影響神經(jīng)肌肉接頭突觸后功能有關(guān)。Themechanismmayandcholinesteraselong-termeffectisrestrained,neuromuscularpostsynapticfunctioning.

.護(hù)理評(píng)估Nursingassessment發(fā)病機(jī)制可37治療原則嚴(yán)超治療原則我們都知道，中毒后，我們要迅速清除毒物，一般來說越快洗胃效果越好TreatmentprincipleAsweknow,themostimportantofallisremovingtoxicasquicklyaswecanwhensomeonepoisoned.Generallyspeaking,thefasterlavagethebettereffectweget.

.治療原則嚴(yán)超治38治療原則幸運(yùn)的是，這個(gè)病人中毒后4小時(shí)就在當(dāng)?shù)蒯t(yī)院洗胃。另外，導(dǎo)瀉也是一個(gè)好辦法。Fortunately,thatpatientlavagedinlocalhospitalafterdrinkingtoxic4hours.Inaddition,guidingdiarrheaisaneffectivemeasure..治療原則幸運(yùn)的是，這個(gè)病人中毒后4小時(shí)就在當(dāng)?shù)蒯t(yī)院洗胃。另外39治療原則第二，促進(jìn)毒物進(jìn)一步排除也十分重要，在此，我們應(yīng)用的是血流灌注。Secondly,promotingdischargepoisonisnecessary,weusedbloodperfusionforher..治療原則第二，促進(jìn)毒物進(jìn)一步排除也十分重要，在此，我們應(yīng)用的40治療原則第三，特殊解毒劑的應(yīng)用，如阿托品、碘解磷定，這取得不錯(cuò)的效果。Thirdly,theapplicationofthespecialeffectsantidotesuchasatropineandpralidoximeiodide.Thus,thedoctorsachievedgoodresultsintheprocessofthattreatmeat..治療原則第三，特殊解毒劑的應(yīng)用，如阿托品、碘解磷定，這取得41治療原則最后也是非常重要的一點(diǎn)，對(duì)癥支持治療。抗感染，促進(jìn)炎癥消散；護(hù)胃，保護(hù)胃黏膜；護(hù)心，治療中毒性心肌炎；Thelastbutnotleast,SymptomaticsupporttreatmentincludingFightinginfectiontopromoteinflammationdissolve;Protectingstomachtocaregastricmucosa；Heartcare,itispositivefortoxicmyocarditis..治療原則最后也是非常重要的一點(diǎn)，對(duì)癥支持治療。Thela42治療原則升壓、降溫，維持生命體征平穩(wěn)很重要鎮(zhèn)靜，細(xì)心照顧他，安慰情緒盡快糾酸和糾正電解質(zhì)紊亂，以穩(wěn)定內(nèi)環(huán)境Elevatingbloodpressureanddecreasingtemperatureareofimportancetomaintainvitalsignssmoothly;weshouldbettercalmdownheremotionandtakecareoftenderly.

Asquicklyaspossibletocorrectacidosisandelectrolytesdisturbancetostableinnercondition..治療原則升壓、降溫，維持生命體征平穩(wěn)很重要Elevatin43護(hù)理診斷

Nursingdiagnosis彭瑜氣體交換受損與肺水腫有關(guān)清理呼吸道無效與呼吸道炎癥、氣道分泌物增多有關(guān)急性神志改變與膽堿能神經(jīng)功能紊亂有關(guān)ImpairedgasexchangeRelatingtopulmonaryedemaAcuteconsciousnesschangingRelatingtocholinergicdisturbancesIneffectiveairwayclearanceRelatingtoairwaysinflammationandairwaysecretionsincreasing.

.護(hù)理診斷Nursingdiagnosis彭瑜氣體44護(hù)理診斷

Nursingdiagnosis有效血容量不足與大量嘔吐、感染等有關(guān)體溫過高與肺部感染、應(yīng)用阿托品等有關(guān)有受傷的危險(xiǎn)與躁動(dòng)不安有關(guān)有猝死的危險(xiǎn)與毒物的重吸收和阿托品使用不當(dāng)有關(guān)RiskforSuddenDeathRelatingtopoisonabsorbingandthewronglyusingofatropineHyperthermiaRelatingtoLungInfectionandapplicationatropineetcRiskforinjuryRelatingtorestlessnessInsufficientofblooddecreaseRelatingtoprofusevomiting,infectionandsoon.

.護(hù)理診斷Nursingdiagnosis有效血容量不足45護(hù)理措施

劉萍迅速清除毒物清除胃內(nèi)毒物催吐：神志清楚、能合作的服毒者，可行催吐。讓患者飲溫水300～500毫升，然后用壓舌板或患者手指刺激咽后壁或舌根部引起嘔吐。

QuicklyremovetoxicremovaloftheundigestedpoisonsEmetic:Thisonlyappliestothepationswhocancooperatewith,Letthepatientdrinkwarmwater300to500ml,andthenwithaspatulaorfingerstimulatepatients,posteriorpharyngealwallorthebaseofthetonguecausedvomiting,

.護(hù)理措施劉萍迅46護(hù)理措施

洗胃：一般在服藥后6小時(shí)內(nèi)洗胃有效，但如果超過6小時(shí)，仍有洗胃的必要。導(dǎo)瀉：洗胃后灌入瀉藥以清除進(jìn)入腸道的毒物，常用硫酸鈉或硫酸鎂。清除皮膚上的毒物脫去污染的衣服，用肥皂水或大量清水沖洗皮膚和毛發(fā)。Gastriclavage:generallywithin6hours.ifmorethan6hours,itisalsonecessaryforgastriclavage.Catharsis:aftergastriclavagewecanfilllaxativestocleartheintestinalpoison,commonlyusedsodiumsulfateormagnesiumsulfate.Cleartheskin.Removecontaminatedclothing,washtheskinandhairwithsoapwater..護(hù)理措施洗胃：一般在服藥后6小時(shí)內(nèi)洗胃有效，但如果超過6小47護(hù)理措施

促進(jìn)已吸收毒物排出利尿絕大多數(shù)毒物由腎臟排泄人工透析PromotionhasbeenabsorbingpoisonoutDiuresis:Thevastmajorityofpoisonexcretedbythekidneys,Artificialdialysis

.護(hù)理措施促進(jìn)已吸收毒物排出Promotionhas48護(hù)理措施

龍麗娟應(yīng)用阿托品的觀察與護(hù)理搶救治療中使用阿托品的原則：早期，足量，快速，反復(fù)給藥，直到阿托品化后再逐漸減量或延長間隔時(shí)間。ApplicationofatropineobservationandnursingTherescueoftheprincipleoftreatmentusingatropine:early,enough,fast,repeateddose,untiltheatropineagainafterreducinggraduallyorextendthetimeinterval.

.護(hù)理措施龍麗娟應(yīng)49護(hù)理措施

阿托品化和阿托品中毒的劑量接近，后者可引起抽搐、昏迷等。因此使用過程中應(yīng)嚴(yán)密觀察病情變化，注意區(qū)別“阿托品化”與阿托品中毒。Thecauseatropineandatropinetoxicdosageisclose,thelattercancauseconvulsions,coma,etc.Thereforewhenusingatropineweshouldmonitortheconditionchanges,andpayattentiontothedistinctionbetweentheatropineandatropinepoisoning..護(hù)理措施阿托品化和阿托品中毒的劑量接近，后者可引起抽搐、昏50護(hù)理措施

阿托品化的表現(xiàn)包括：①意識(shí)清楚或模糊②顏面潮紅、干燥③瞳孔由小擴(kuò)大后不再縮小④體溫正?；蜉p度升高⑤心率≦120次／分，脈搏快而有力。Theperformanceofatropineinclude:(1)clearconsciousnessorfuzzy(2)redanddryface(3)thepupilbecomebigandnotsmallanymore(4)andthetemperatureisnormalorlittleraise(5)theheartrateismorethan120timeseveryminute,andthepulsefastandpowerful.護(hù)理措施阿托品化的表現(xiàn)包括：Theperformance51護(hù)理措施

阿托品化的表現(xiàn)包括：①意識(shí)清楚或模糊②顏面潮紅、干燥③瞳孔由小擴(kuò)大后不再縮小④體溫正?；蜉p度升高⑤心率≦120次／分，脈搏快而有力。Theperformanceofatropineinclude:(1)clearconsciousnessorfuzzy(2)redanddryface(3)thepupilbecomebigandnotsmallanymore(4)andthetemperatureisnormalorlittleraise(5)theheartrateismorethan120timeseveryminute,andthepulsefastandpowerful.護(hù)理措施阿托品化的表現(xiàn)包括：Theperformance52護(hù)理措施

阿托品中毒的表現(xiàn)包括：①譫妄、躁動(dòng)、幻覺、雙手抓空、抽搐、昏迷②皮膚紫紅、干燥③瞳孔極度散大④高熱，T＞40℃⑤心動(dòng)過速，甚至有室顫發(fā)生Atropinepoisoningperformanceincluding:(1)thedelirium,agitated,illusion,convulsions,coma(2)amaranthineanddryskin(3)thepupilsextremelyenlarge(4)highfever,thetemperature>40centigrade(5)tachycardiaandevenaventricularfibrillationhappen..護(hù)理措施阿托品中毒的表現(xiàn)包括：Atropinepoiso53護(hù)理措施

王潔應(yīng)用膽堿酯酶復(fù)能藥的觀察和護(hù)理首先,你必須盡早用藥。第二,輕度中毒,你可以單獨(dú)使用這個(gè)藥物,但是中度以上中毒,你必須和阿托品一起使用。Theclinicalobservationandnursingoftheapplicationofacetylcholinesterase：First，youmustusethemedicineearly.Second,lightpoisoningyoucanusethemedicine,butifbadpoisoning,youcanusetheatropinetogether..護(hù)理措施王潔應(yīng)用膽堿54護(hù)理措施

第三,很高的濃度或快速注射能引起中毒，所以你必須稀釋后使用，注意給藥速度。第四,不可皮下注射，確定針頭在血管內(nèi)方可用藥。Third,Muchhighconcentrationorfastinjectioncancausepoisoning.soyoumustdilutethemedicine.Payattentiontothemedicinespeed.Fourth,youcannotuseanintramuscularinjection.Whenyouwanttoinjectit,youmustdefinethepininthevein..護(hù)理措施第三,很高的濃度或快速注射能引起中毒，所以你必須稀55護(hù)理措施丁廣湘

氣管插管和呼吸機(jī)的護(hù)理體位：患者臥床休息，予抬高床頭30~40°固定：導(dǎo)管固定要牢靠，確定導(dǎo)管已準(zhǔn)確插入氣管后，用長膠布將導(dǎo)管和牙墊一起捆扎固定；Trachealintubationandbreathingmachinecare.BodyPosition:bedrestforthepatientwithbedraising30~40°Fix:Thecathetershouldbefirmlyfixedtomakesurethatitisinsertedintotracheaandbetiedtogetherwithteethcushionthroughadhesiveplaster;.護(hù)理措施丁廣湘56護(hù)理措施

氣道護(hù)理氣道的濕化保持氣道通暢—吸痰Periodicallycheckthedepthoftracheaandcatheter,auscultationbreathsoundsfromlungs.Bereadyforbedsideshift.AirfluecareAirwayhumidificationMaintainairwayunobstructedSuctionphlegm..護(hù)理措施氣道護(hù)理Periodicallycheckth57護(hù)理措施

密切觀察生命體征、spo2、神志、皮膚面色、出入量、觀察人機(jī)是否同步，并做好記錄。心理護(hù)理。Closeobservationofvitalsigns、spo2、consciousnessandskincomplexion.Observewhethermanandmachinearesynchronization.PsychologicalCare..護(hù)理措施密切觀察生命體征、spo2、神志、皮膚面色、出入58護(hù)理措施

劉斌患者機(jī)械通氣病程長，機(jī)體抵抗力低下,口腔自凈作用和黏膜抵抗力減弱，使大量細(xì)菌在口腔里繁殖，容易造成口腔感染。Oralcavitynurse.Theprocesswithmachineryventilationofpatientislong,herorganismresistibilityislow,oralcavity'sautomaticdepurationfunctionandthemucousmembraneresistibilityareweaken,somassivebacteriareproduceinsidetheoralcavityanditiseasytobeinfected.

.護(hù)理措施劉斌患者機(jī)械59護(hù)理措施

有機(jī)磷農(nóng)藥中毒的病人的口中會(huì)有大蒜樣臭味,并且口腔黏膜干燥、唾液分泌減少，因此應(yīng)做好口腔護(hù)理、保持口腔的清潔和濕潤,每日高質(zhì)量的口腔護(hù)理是預(yù)防口腔并發(fā)癥和肺部感染的重要方法之一.ThepatientwhoispoisoningbyAOPPwillhavethegarlicstink,theiroralcavitymucousmembranedryandsalivareducesatthesametime,thereforetheyshouldcompleteoralcavitynursing,maintainoralcavitycleanandthemoistness,everydayhighgradeoralcavitynursingisoneoftheimportantmethodsinpreventingoralcavitycomplicationandlungsinfection..護(hù)理措施有機(jī)磷農(nóng)藥中毒的病人的口中會(huì)有大蒜樣臭味,并且口腔60護(hù)理措施

中毒后肌肉震顫導(dǎo)致產(chǎn)熱增加，大量阿托品應(yīng)用后出現(xiàn)散熱障礙，均可致體溫上升。Afterthepoisoning,themuscletremblescausestoproduceincreaseshotlyandheatdissipationbarrierwillappearaftermassiveatropineapplication,bothofthemmayleadtobodytemperaturerising..護(hù)理措施中毒后肌肉震61護(hù)理措施

一般低度或中度發(fā)熱不需處理，如出現(xiàn)高熱，可以采取物理降溫，同時(shí)可以給病人補(bǔ)充液體以達(dá)到降溫，一般不用藥物降溫。Normallyormoderatefeverheatneedn’ttodealwith.Butifitpresentsthehighfever,wemayadoptthephysicalcooling.Simultaneouslywemaysupplementtheliquidforpatienttodecreasethebodytemperature,generallywedon’tneedthemedicineforcooling..護(hù)理措施一般低度或中度發(fā)熱不需處理，如出現(xiàn)高熱，可以采取物62護(hù)理措施

羅富群飲食重度中毒一般需禁食3-5天，待病情穩(wěn)定，意識(shí)清醒后可以口服蛋清以保護(hù)胃粘膜，禁食刺激性及含油脂多的食物。DietSeverepoisoning,whichnormallytakes1-3daysoffasting,beinstablecondition,consciousandaliveafteroraltemperatureofliquideggwhitetoprotectthegastricmucosa,Prohibittheconsumptionofirritatingandgreasyfastfoodandmore..護(hù)理措施羅富群飲食Die63護(hù)理措施

昏迷3-5天患者鼻飼飲食，注意補(bǔ)充維生素和無機(jī)鹽，供給足夠的優(yōu)質(zhì)蛋白。Comainpatientswithnasalfeedingdietfor3-5days,payattentiontovitaminandmineral,thesupplyofadequatequalityprotein..護(hù)理措施昏迷3-5天患者鼻飼飲食，注意補(bǔ)充維生素和無機(jī)鹽，64護(hù)理措施

何蓉安全護(hù)理患者昏迷，躁動(dòng)不安，應(yīng)派專人護(hù)理，防止意外發(fā)生。必要時(shí)對(duì)其用約束帶限制其四肢活動(dòng)，但應(yīng)防止約束過緊，定時(shí)放松，以免造成局部末梢循環(huán)障礙和皮膚損傷。必要時(shí)使用鎮(zhèn)靜藥。SafeComapatientswithrestless,shouldsendsomeonetocare,topreventaccidents.Whenitisnecessarytouseconstraintstolimittheirlimbswithactivities,butshouldpreventbindingtight,timetorelax,toavoidlocalperipheralcirculationdisordersandskinlesions.Usesedativewhennecessary.

.護(hù)理措施何蓉安65護(hù)理措施

劉芳心理護(hù)理待患者病情穩(wěn)定后轉(zhuǎn)入單間病房，保持室內(nèi)清潔安靜。防止圍觀，注意保護(hù)隱私。建立良好的護(hù)患關(guān)系，予以心理支持；良好的護(hù)患關(guān)系可使患者產(chǎn)生信任感和安全感。用心理解患者苦惱，允許患者發(fā)泄，鼓勵(lì)其哭訴，讓不良情緒充分釋放出來。PsychologicalNursingTobetransferredtoasinglepatientinstableconditionafterward,tokeeptheroomcleanquiet.Preventonlookers,toprotectprivacy.Establishagoodnurse-patientrelationship,toheartsupport;goodnurse-patientrelationshipallowspatientsasenseoftrustandsecurity.Hardtounderstanddistressinpatients,allowingpatientstovent,toencouragetheirtears,sofullofnegativeemotionsreleased..護(hù)理措施劉芳Psyc66護(hù)理措施

醫(yī)護(hù)人員及家屬盡量不在患者面前談?wù)摬∏楹皖A(yù)后，及時(shí)將良性信息反饋給患者，并盡快取得患者家屬的配合,幫助患者尋求有效支持；實(shí)施心里護(hù)理除了直接面對(duì)患者外，同時(shí)還需給予患者家屬心里疏導(dǎo)。使其更體恤患者處境，主動(dòng)深入患者的內(nèi)心世界，為患者贏得跟多的支持。Healthcareworkersandtheirfamiliesbeforethepatientisnotasmuchaspossibleabouttheconditionandprognosis,andtimelypositivefeedbacktopatients,andpatientsassoonaspossiblewiththefamilies,relativesandfriendstotemporarilytakecareoffamilyresponsibilities,torelievethepatient'sworries,assoonaspossiblesothatpatientsunderstandingoftheirattendingdoctorsandnurses..護(hù)理措施醫(yī)護(hù)人員及家屬盡量不在患者面前談?wù)摬∏?7護(hù)理措施

找到有效的支持,以幫助病人;實(shí)施心理護(hù)理除了直接面對(duì)病人,家庭成員也很重要，讓它們更加同情病人的現(xiàn)狀,積極深入病人內(nèi)在的世界。Tohelppatientsfindeffectivesupport;implementationofheartcareinadditiontodirectlyfacethepatient,thefamilymembersofpatientsalsoneedtogivemyheartease.Makeitmoresympathetictothesituationofpatients,activein-depthpatient‘sinnerworld.

.護(hù)理措施Tohelppatientsfindeff68相關(guān)知識(shí)

Hemoperfusionisamedicalprocedurewhichisusedtocleansethebloodoftoxins.Duringthisprocessthebloodispassedthroughanadsorbentmaterialwhichattractstoxicsubstances.血液灌流是指將血液通過體外循環(huán)．經(jīng)過具有廣譜解毒作用的吸附裝置，以清除血中外源性或內(nèi)源性毒物，從而達(dá)到血液凈化的一種醫(yī)療治療方法。

WhatIsHemoperfusion?什么是血液灌流?.相關(guān)知識(shí)Hemoperfusionisam69護(hù)理措施

血液灌流的實(shí)質(zhì)是血液吸附，即溶解在血中的物質(zhì)被吸附到具有較大表面積的固形物質(zhì)上去，從而清除血中有毒物質(zhì)。目前常用的吸附劑有兩種：一類是活性炭，一類是合成樹脂。

Theadsorbentmaterialisusuallycharcoaloractivatedcarbonfixedtoasolidsurfaceinsideacolumn.Duringtreatment,thepatient’sbloodispassedthroughthecolumnandtoxinsbindtotheadsorbentmaterial,allowingcleansedbloodtoflowoutofthecolumn.Thisprocesscontinuesuntilasmuchtoxicmaterialaspossiblehasbeenremovedfromtheblood..護(hù)理措施血液灌流的實(shí)質(zhì)是血液吸附，即溶解在血中70護(hù)理措施

HemoperfusionisusuallycarriedoutforSeveralreasons.進(jìn)行血液灌洗通常有幾種原因。whenitisused?適應(yīng)癥.護(hù)理措施whenitisused?.71護(hù)理措施

首先,血液灌流主要用于急性藥物或毒物中毒，特別是胎溶性毒物或與蛋白結(jié)合的毒物。血液灌洗等能成功地排除毒素和代謝廢物.First,theprocedureisusedasanemergencymedicaltreatmentincaseswhereapatienthasingestedalargeamountofasubstancewhichistoxictothekidneys。Hemoperfusioncansuccessfullyremovetoxinsorwasteproductswhicharepresentinapatient’sblood.

.護(hù)理措施First,theprocedureisu72護(hù)理措施

其次，血液灌流對(duì)于那些接受臟器移植（如肝臟，腎臟移植）是一種輔助治療，移植患者在此之前和之后接受血液灌流，這樣受體臟器就不會(huì)負(fù)擔(dān)過重。Second.,thisprocessisusedasasupportivetreatmentforpeoplewhoareundergoingalivertransplant,Beforeandafterthetransplantitself,patientsundergobloodcleansingsothatthenewly-transplantedliverisnotoverburdened.

.護(hù)理措施Second.,thisprocessis73護(hù)理措施

最后，血液灌洗等也是一種輔助治療患者腎功能衰竭的透析治療方法。

Finally.Hemoperfusionisalsoatypeofdialysis,itisusedasasupportivetreatmentforpeoplewithkidneyfailure..護(hù)理措施Finally.Hemoperfusionis74護(hù)理措施

最后，血液灌洗等也是一種輔助治療患者腎功能衰竭的透析治療方法。

Finally.Hemoperfusionisalsoatypeofdialysis,itisusedasasupportivetreatmentforpeoplewithkidneyfailure..護(hù)理措施Finally.Hemoperfusionis75護(hù)理措施

洗胃時(shí)間一般認(rèn)為，洗胃的時(shí)間應(yīng)該在6小時(shí)內(nèi)。超過6小時(shí)就沒有洗胃的必要。但事實(shí)證明：有些患者服毒超過6小時(shí)，其胃液和嘔吐物仍有蒜臭味，表明毒物存在。因此，首次洗胃后，應(yīng)該保留胃管24小時(shí)，每隔4小時(shí)重復(fù)洗胃一次，直到癥狀好轉(zhuǎn)。GastriclavagetimeGenerallythought，Thegastriclavagetimeshouldin6hours.It’sunnecessarywhenthetimelongerthan6hours.Somesuffererscommitbypoisonlongerthan6hours,it’sstomachliquidandvomitsathingtostillhavegarlicbadsmell,expresspoisonexistence.Therefore,fortheveryfirsttimeafterwashingstomach,shouldreservestomachandtakecareoffor24hours,againwashstomachevery4houronce,untilsymptomamendment..護(hù)理措施Gastriclavagetime.76護(hù)理措施

胃管長度有研究證明：將胃管長度由45—55cm延長到55—70cm，使胃管側(cè)孔全部在胃內(nèi)，可使患者不論取何種體位，均達(dá)到洗胃液流出快、通暢，洗胃時(shí)間短，洗胃徹底的目的，為搶救贏得了寶貴的時(shí)間。GastrictubelengthResearchproves:willthetubelengthby45-55cmextendto55-70cm,makegastrictubesideholesinthestomach,allwithincanmakepatientstakenomatterwhatposition,achieveswashoutfast,unobstructed,gastriclavagetimeisshort,lavagecompletely,forthepurposeoftherescuetowintheprecioustime..護(hù)理措施Gastrictubelength.77護(hù)理措施

導(dǎo)瀉有研究認(rèn)為：在早期充分洗胃的基礎(chǔ)上給予有效導(dǎo)瀉處置，可充分地清除已進(jìn)入患者體內(nèi)但尚未吸收人血的有機(jī)磷成分，減輕中毒癥狀。即使中毒已超過6小時(shí)，3天內(nèi)未予導(dǎo)瀉處理者，仍應(yīng)給予有效的導(dǎo)瀉。CatharsisAstudyfoundthatintheearlydaysonthebasisoffullylavageprovideeffectiveguide,anditcanfullydiarrheadisposaltoremovehasenteredintothepatients'bodiesbutnotyetabsorbbloodcomposition.Evenmorethansixhourspoisoninghaswithinthreedays,stillshouldgiveeffectivecatharsis..護(hù)理措施Catharsis.78護(hù)理措施

阿托品化有學(xué)者認(rèn)為，在AOPP患者中有30％始終不出現(xiàn)瞳孔散大，心率增快的速度變慢。這是因?yàn)樗麄儗?duì)抗膽堿劑的耐受性增加。為此，提出把心率維持在80—100次／分，口腔、皮膚干燥，是判斷阿托品化較為可靠，而且是相對(duì)穩(wěn)定的指標(biāo)，稱為“簡化阿托品化”。

AtropinizationSomescholarsthink，AOPPin30%ofpatientsnotalwaysappearinallpupil,heartrateincreasespeedslowbecausetheyfightchorineagent'stoleranceincreases，F(xiàn)orthis,putforwardtheheartratein80-100,oralcavity,dryskin,isthemorereliablejudgmentatropinization,andarerelati